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Research from the UC Davis Comprehensive Cancer Center challenges current strategies

(SACRAMENTO, Calif.) —

When it comes to a specific type of pancreatic surgery, post-operative complications have a far greater impact on total cost than does how long the patient stays in the hospital, according to a published paper by UC Davis researchers.

Rick Bold

The finding, published in JAMA Surgery, challenges current cost-cutting strategies routinely used by administrators and insurers that emphasize shorter lengths of stay in the hospital. Results of the new study point to a different, potentially more effective approach: a focus on reducing surgery complications.

The surgery examined for this study was the pancreaticoduodenectomy, a major operation that involves removal of parts of the stomach, duodenum, pancreas, bile duct and gallbladder. The surgery is performed to remove cancerous tumors or to deal with an inflamed pancreas.

“Hospitals are increasingly motivated to implement clinical care pathways as a method of improving quality of care, with a focus on elimination of excess resource utilization and shortening the hospital length of stay,” said lead author Richard Bold, professor and chief of surgical oncology at the UC Davis Comprehensive Cancer Center. “This study’s results reveal that addressing post-operative complications should be a critical component of these pathways.”

For the study, researchers reviewed records of 89 patients who had undergone a pancreaticoduodenectomy. They found that post-operative care for patients who developed complications proved to be unusually costly. In fact, the 34 patients with complications (38 percent) drove up the total average cost for all 89 patients far more dramatically than any difference in hospital length of stay.

“There’s an exponential increase in cost once there’s a complication, with an impact on hospital charges that far outpaces a long hospital stay,” explained Bold. “This is an under-recognized factor in the valuation of care.

“Rather than striving for shorter length of stay, quality efforts should go toward avoiding complications and decreasing mortality,” Bold added. “Our focus as surgeons ought to be reaffirming what we all believe — that we should strive for outcomes, and outcomes will derive value.”

Earlier studies have established that success rates for this surgery are far higher if the surgery is performed in a tertiary care center that routinely performs many of these surgeries and if the surgeon has conducted a significant number of them. Pancreaticoduodenectomies of patients chosen for this study were performed by three experienced surgeons at the UC Davis Comprehensive Cancer Center.

Thirty-eight percent of the patients developed at least one complication, accounting for 92 percent of readmissions, and 13 percent had more than one complication. The three most common complications were:

delayed gastric emptying (38 percent), which slightly decreased the cost, likely related in part to the intensity of therapy beyond early post-operative care

The exponential relationship between hospital length of stay and charges for patients with complications — in comparison to the linear relationship for patients without — demonstrates that a complication has an impact on increased charges above and beyond that of a prolonged hospitalization, the authors conclude.

Other study authors are Erin G. Brown, Anthony Yang, and Robert J. Canter, all of UC Davis.

UC Davis Comprehensive Cancer CenterUC Davis Comprehensive Cancer Center is the only National Cancer Institute-designated center serving the Central Valley and inland Northern California, a region of more than 6 million people. Its specialists provide compassionate, comprehensive care for more than 10,000 adults and children every year, and access to more than 150 clinical trials at any given time. Its innovative research program engages more than 280 scientists at UC Davis, Lawrence Livermore National Laboratory and Jackson Laboratory (JAX West), whose scientific partnerships advance discovery of new tools to diagnose and treat cancer. Through the Cancer Care Network, UC Davis collaborates with a number of hospitals and clinical centers throughout the Central Valley and Northern California regions to offer the latest cancer care. Its community-based outreach and education programs address disparities in cancer outcomes across diverse populations. For more information, visit cancer.ucdavis.edu.